Blepharospasm, hemifacial spasm and Botulinum toxin (Botox)

The spasm of the fine muscles of the face and eyes can be at best annoying and at worst debilitating.  It tends to become more common as we get older.  It can be severe and prevent patients doing their normal activities.  It can also be socially embarrassing.

Botulinum toxin (commonly referred to by the trade name Botox®) is an effective way to manage these spasms and provide very welcome relief.  Given the special anatomy of the eye lids and the muscles around the upper face an ophthalmic surgeon is often the best person to manage these specific conditions.

Dr Hay-Smith is an experienced ophthalmologist and is skilled in using botulinum toxin.  He was trained at the world leading National Hospital for Neurology and Neurosurgery and at Moorfields Eye Hospital in the use of Botulinum toxin and used to run a clinic for the UK National Health Service for patients suffering from facial, hemifacial and blepharospasm.  He is also approved by the Pharmaceutical Benefits Scheme (Section 100 - Highly Specialised Drugs Program) which permits him to use botulinum toxin at standard prescription rates.

Treatment consists of injection given with a very fine needle at carefully chosen positions around the eye and face.  Each treatment can last up to 6 months - and can sometimes be curative though it is more common to have more than one course of treatment.  Every patient is different and Dr Hay-Smith will adjust the treatments to suit the individual.


What is botulinum toxin?

Botulinum Toxin is a drug made from a toxin, called Botulinum, which is produced by the bacterium Clostridium botulinum..
Chemical messages produced by our body affect and control our muscles and their contractions. Sometimes, the coordination of this complicated process is not as effective as expected. The Botulinum toxin targets these chemical messages, stopping them temporarily by blocking the nerve signals.
In small doses, doctors have administrated the toxin safely to help patients on the treatment of severe sweating, cervical dystonia, blepharospasm and facial spasms. There are also cosmetic uses (not covered by Medicare) such as facial wrinkles, frown lines, crow’s feet and horizontal lines on the forehead and on the treatment of Strabismus.



How do I know if I can benefit from Botulinum Toxin?

In cases of blepharospasm, Botulinum toxin can be used to stop the uncontrolled spasm, twitch and involuntary closing of the eyelid, by blocking the signals that stimulates the muscles’ contraction.
Hemifacial spasms can also be controlled with the use of Botulinum toxin, which, used appropriately targets the uncontrolled contraction of the facial muscles, relaxing the spasms.
It is important to keep in mind that the effect will normally last for three to six months, depending on each case before it needs repeating.


Is the procedure painful?

The Botox injection is almost painless. The dosage used is very small and the procedure is made directly into the affected muscles through a very thin needle by a skilled surgeon.


How successful is the injection?

Botulinum toxin therapy is a safe and effective treatment. After the injection, eyelid movements can be slightly affected, but after a couple of hours all movements are usually back to normal. The full effect is seen after a couple of days and longevity of the treatment depends on the individual and the specific problem treated.
The number of injections required will vary from patient to patient. They often need repeating after 3-6 months.
It is important to not rub or massage the treated area in the hours after the procedure.


What is important to take into consideration before the Botulinum Toxin injection?

Make sure you advise your doctor if you have had any previous treatments involving the Botulinum toxin. Remember to advise on any allergies and medications taken regularly or recently, including blood thinners, muscle relaxants and sleeping pills.
If you are pregnant or breastfeeding you should not have treatment.


What are possible side-effects or complications?

Side-effects are uncommon. After the injection the patient can experience pain, swelling or bruising at the area affected. Some patients also suffer symptoms similar to the flu, headaches, nauseas, temporary eyelid drop (Ptosis) and dry eyes.
It is important to get a referral from your doctor as Botulinum toxin treatments must be carefully handled by a specialist that will advise you on the procedure and determine the need in your specific case.
If you experience any severe problems, such as lack of vision, difficulties in speaking, swallowing and/or breathing, you must contact your doctor straight away or dial 000 and ask for an ambulance. Such occurrences are extremely rare.


How much do I have to pay?

For those patients entitled to Medicare and that are having botulinum toxin injections as treatment of a health problem (not a cosmetic procedure), the Australian Government will cover the costs of the medication less the costs of a prescription charge. You will have to pay for your doctor and the clinic fees. Estimates of costs can be provided by our team upon request as they do vary from case to case.  They tend to be a little more, but not usually much more, than a standard consultation fee.

For those patients seeking a cosmetic treatment, the full price of the Botulinum toxin will be charged, as well as the doctor and clinic fees.
Those who have a private Health Insurance, which do not have exclusions for cosmetic services, might have their fees covered by the Health Fund. Ask our team if you have any doubts and we will help you understand both the conditions and options.
For more information on eligibility from Medicare please visit: